论文标题
NSCLC中P40/TTF1共表达的临床病理学相关性和相关文献的综述
Clinicopathological correlation of p40/TTF1 co-expression in NSCLC and review of related literature
论文作者
论文摘要
由于其敏感性和特异性，TTF1和ΔNP63/p40已用于在低分NSCLC中区分ADC和SQC。在很少有情况下，TTF1和ΔNP63/p40在同一肿瘤细胞中共同表达，并且对此类病例的临床病理特征，治疗和预后知之甚少。我们研究了电子显微镜特征，免疫组织化学表达和TTF1/p40病例共表达NSCLC的分子变异，并审查并总结了相关文献。我们的患者是一名58岁的男性，CT显示左侧肺部占用。与文献中报道的所有其他情况一样，肿瘤均表现出与多边形细胞，嗜酸性细胞质和清晰可见的核裂变的固体生长模式。免疫组织化学对TTF-1，P40，CK5/6，CK7，P63和P53的呈阳性，而Napsina和Alk为阴性。电子显微镜显示出以腺细胞和鳞状细胞的双向分化为特征的肿瘤细胞，与先前的报道一致。在这种情况下，第二代测序表明STK11/LKB1和NF1基因的共同享有共同蒙受。在ADC和SQC中发现了STK11/LKB1和NF1基因中的突变，并且通常与耐药性和预后不良有关，但是尚未报告STK11/NF1 COMON，需要更多的病例来揭示这种关联。 NSCLC中的P40/TTF1共表达可能是NSCLC的识别型不足的变体，起源可能是位于远端气道的双阳性干细胞基基基细胞，其快速临床进展和预后不良。
TTF1 and ΔNp63/p40 have been used to differentiate ADC and SQC in hypofractionated NSCLC because of their sensitivity and specificity. There are few cases where TTF1 and ΔNp63/p40 are expressed together in the same tumour cells, and little is known about the clinicopathological features, treatment and prognosis of such cases. We investigated the electron microscopic features, immunohistochemical expression and molecular variation of a case of TTF1/p40 co-expressing NSCLC and reviewed and summarised the relevant literature. Our patient was a 58-year-old male with a CT showing a left-sided lung occupancy. As in all other cases reported in the literature, the tumour showed a solid growth pattern with polygonal cells, eosinophilic cytoplasm and clearly visible nuclear fission. Immunohistochemistry showed positive for TTF-1, p40, CK5/6, CK7, P63 and p53, and negative for NapsinA and ALK. Electron microscopy showed tumour cells characterised by bidirectional differentiation of adenocytes and squamous cells, consistent with previous reports. Second-generation sequencing suggested co-mutation of STK11/LKB1 and NF1 genes in this case. Mutations in STK11/LKB1 and NF1 genes have been found in ADC and SQC and are often associated with drug resistance and poor prognosis, but STK11/NF1 co-mutation has not been reported and more cases are needed to reveal the association. p40/TTF1 co-expression in NSCLC may be an under-recognised variant of NSCLC The origin may be a double positive stem cell-like basal cell located in the distal airway, with rapid clinical progression and poor prognosis.
